• Maxillofacial Plastic and Reconstructive Surgery
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• 제16권3호
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• pp.397-418
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• 1994

Microvascular surgery has been widely used in the clinical field of replantation and reconstructive surgery. Since the last 20 years, microsurgical techniques and instruments have been rapidly developed and the success rate is remarkably increased. But thrombotic occlusion of vessels remains the major reason for clinical failure. The change of vessel wall is the most important factor in thrombus formation. If we can reduce the traumatic changes in the vessel walls during surgery, the success rate can be markedly increased. For this study, femoral arteries and veins of 36 Sprague-Dawley rats with average weights of 300gm were used. The author observed the histological changes and healing process in the anastomostic site after 1 hour, 24 hours, 1, 2, 3 and 4 weeks under light microscopy and scanning electron microscopy. The results were as follows : 1. The patency rate was 100% in femoral arteries and 85% in femoral vein. 2. At the early stages after microvascular anastomosis, the loss of endothelial cell in the vessel walls was observed in the wide area including anastomotic site. In scanning electron microscopic finding the anastomotic site was covered with much fibrin, many red blood cells and some platelets. 3. At 1st week, new endothelial cells were formed toward anastomotic site and at 3rd week, the anastomotic site was completely covered by new endothelial cells. At 4th week, the complete endothelialization over the threads was observed. 4. The media extended from the anastomotic site toward the end of the specimen. At later stages, the extent of media necrosis was markedly decreased. But the media necrosis of anastomotic site was not regenerated till 4th week. 5. Intimal hyperplasia appeared at 1st week and increased till 4th week. The layer consisted of endothelialization the most luminal layers and smooth muscle in the deeper layers. But in veins, the response was less pronounced than in arteries. 6. Foreign body granuloma remained during 4 weeks and aneurysm was observed at 3rd week in artery. In aneurismal wall, media necrosis, loss of elastic lamina and intimal hyperplasia were seen.

• Clinical and Experimental Reproductive Medicine
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• 제36권1호
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• pp.35-43
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• 2009

목 적: 정액 내 tumor necrosis factor-alpha (TNF-${\alpha}$) 농도와 정자 DNA 손상 및 정액 검사 소견과의 관련성을 평가하고자 하였다. 연구방법: 정액 표본은 45명의 건강한 남성에서 자위에 의하여 획득하였다. 정자의 상태는 컴퓨터 정액 분석기를 이용하여 판정하였으며, 두부의 DNA 손상은 TUNEL 분석방법에 의해 측정하였다. TNF-${\alpha}$ 농도는 동결-융해된 정장액에서 ELISA법으로 측정하였다. 결 과: 정자 DNA 손상율은 1.9%에서 53% (mean ${\pm}$ SD, 12.4${\pm}$9.6%)로 매우 광범위하게 나타났다. 단변량분석에 의하면 DNA 손상 정도와 정자의 농도, 운동성과는 관련이 없었으나, 직진운동성 (linearity)과는 음의 상관 관계를 나타내었으며 (r=-0.325, p=0.03) 연구 대상 남성의 연령과는 양의 상관 관계를 나타내었다 (r=0.484, p=0.001). 정액내에 존재하는 TNF-${\alpha}$ (>1 pg/mL)는 연구 대상 남성의 73.3% (33/45)에서 검출되었으며 평균 농도는 4.9 pg/mL, 범위는 1.1에서 22.6 pg/mL이었다. 정액 검사 상의 정자 상태와 정자 DNA 손상과는 유의한 관련성이 나타나지 않았다. 결 론: 본 연구에서는 정자 DNA의 손상이 남성의 연령과 관련성이 있음을 확인하였으나, TNF-${\alpha}$와의 관련성은 확인할 수 없었다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권4호
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• pp.287-294
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• 2006

Vascular thrombosis and ischemic necrosis still remain the most significant threats to the survival of free flaps. To date, neutrophils have been implicated in the pathogenesis of postischemic injury. Several studies have demonstrated that modulating the neutrophil response to ischemia-reperfusion injury can decrease the extent of the injury. In addition, some authors noticed that mast cell counts were also increased in flaps exposed to state of ischemia/reperfusion. So, we designed to evaluate the role of mast cells in ischemia/reperfusion by blocking histamine and to compare the effect of L-arginine, a nitric oxide precursor which is known to prevent neutrophil-mediated tissue injury. Epigastric island skin flaps were elevated in 30 rats and rendered ischemic. Thirty minutes prior to reperfusion, the rats were treated with intraperitoneal saline, diphenhydramine, cimetidine, and L-arginine. The necrosis rate of flap at 7 days, the number of neutrophils and mast cells at 20 hours were evaluated. In conclusion, histamine receptor blockers as well as L-arginine significantly decreased flap necrosis in a rat skin island ischemia-reperfusion flap model, but the protective effect was not significantly different in both agent groups.

• 한국발생생물학회지:발생과생식
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• 제5권2호
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• pp.101-106
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• 2001

Insulin과 tumor necrosis factor alpha(TNF-$\alpha$)에 의한 초기 배아 발생의 조절기작을 알아보고자 생쥐의 상실배를 대상으로 이들이 첨가된 배양액에서 형태발생, 세포증식을 조사하고, 포배에서 mitogen activated protein kinase(MAPK, ERK1/2)의 활성 변화에 미치는 영향을 조사하였다. Insulin은 상실배의 체외발생 및 포배내 할구 수를 대조군에 비해 유의하게 증가시켰으며, TNF-$\alpha$는 발생율을 유의하게 감소시켰다. Insulin은 TNF- $\alpha$에 의한 배아 발생율 감소를 완화하였다. TNF-$\alpha$는 농도에 의존적으로 MAPK 활성을 감소시켰으며, insulin은 포배에서 MAPK의 활성을 유의하게 증가시킨 반면 TNF-$\alpha$는 처리농도에 의존적으로 MAPK 활성을 감소시켰다. 50 ng/ml 농도의 TNF-$\alpha$를 전처리한 포배에서는 insulin에 의한 MAPK 활성의 증가가 저해되었다. 이러한 결과로부터 생쥐의 착상전 초기 배아 발생조절에 insulin과 TNF-$\alpha$ 사이에 MAPK를 경유하는 cross talk이 존재함을 확인하였고 insulin은 TNF-$\alpha$ 에 의한 배아의 손상을 억제하는 것으로 사료된다.

• Archives of Plastic Surgery
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• 제41권6호
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• pp.740-747
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• 2014

Background Autologous fat graft has become a useful technique for correction of acquired contour deformity in reconstructed breasts. However, there remains controversial regarding the efficacy and safety of the practice for reconstructive breast surgery. Methods A retrospective review was performed on 102 patients who had secondary fat grafting after breast reconstruction. Fat harvest, refinement and injection were done by Coleman's technique. All patients were followed up postoperatively within 1 month and after 6 months including physical examination and ultrasonography. In 38 patients, the reabsorption rate was calculated by serial changes of thickness between skin and pectoral fascia in the ultrasonic finding. Locoregional recurrence rate was compared with control group of 449 patients who had breast reconstruction without fat graft in the same time period. Results Average 49.3 mL fat was injected into each breast. The most common location of fat graft was upper pole, followed by axilla, lower and medial breasts. During 28.7 months of average follow-up period, 2.9% of total patients had symptoms of palpable mass on fat graft side and ultrasonography identified fat necrosis and cyst formation in 17.6% of the patients. Calculated fat reabsorption rate was 32.9%. Locoregional recurrence was occurred in 1 patient (0.9%) and the rate was not different significantly with control group (2%). Conclusions Although further studies are required to provide surgeons with definitive guidelines for the implementation of fat grafting, we propose autologous fat graft is an efficient and safe technique for secondary breast reconstruction.

• Annals of Surgical Treatment and Research
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• 제95권6호
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• pp.324-332
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• 2018

Purpose: We present our experience involving the management of this disease, identifying prognostic factors affecting treatment outcomes. Methods: The patients treated for Fournier gangrene at our institution were retrospectively reviewed. Data collected included demographics, extent of soft tissue necrosis, predisposing factors, etiological factors, laboratory values, and treatment outcomes. The severity index and score were calculated. Multivariate regression analysis was used to determine the association between potential predictors and clinical outcomes. Results: A total of 41 patients (male:female = 33:8) were studied. The mean age was 54.4 years (range, 24-79 years). The most common predisposing factor was diabetes mellitus (n = 19, 46.3%). Sixteen patients (39.0%) were current smokers. Seven patients had chronic kidney disease. The most frequent etiology was urogenital lesion (41.5%). The mortality rate was 22.0% (n = 9). Multivariate regression analyses showed that extension of necrosis beyond perineal/inguinal area and pre-existing chronic kidney disease were significant and independent predictors of mortality. Extension of necrosis beyond perineal/inguinal area was a significant predictor of increased duration in the intensive care unit and hospital stay. In addition, pre-existing chronic kidney disease was a significant predictor of flap reconstruction in the wound. Conclusion: Fournier gangrene with extensive soft tissue necrosis and pre-existing chronic kidney disease was associated with poor prognosis and complexity of patient management. Early recognition of dissemination and premorbid renal function is essential to reduce mortality and establish a management plan for this disease.

• Childhood Kidney Diseases
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• 제23권1호
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• pp.53-57
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• 2019

Renal cortical necrosis (RCN) is patchy or diffuse ischemic destruction of the renal cortex caused by significantly reduced renal arterial perfusion. It is a rare cause of acute kidney injury (AKI) and is associated with high mortality. Here, we review the case of RCN in a 15-year-old boy who developed AKI. A 15-year-old boy was referred to our hospital from a local hospital due to a sharp decrease in his renal function. He presented with acute flank pain, nausea with vomiting, and oliguria for the past two days. He had taken a single dose of antihistamine for nasal congestion. At our hospital, his peak blood pressure was 148/83 mmHg and he had a high body mass index of $32.9kg/m^2$. The laboratory data showed a blood urea nitrogen (BUN) of 28.4 mg/dL, a creatinine of 4.26 mg/dL, and a glomerular filtration rate estimated from the serum cystatin C of $20.2mL/min/1.73m^2$. Proteinuria (spot urine protein to creatinine ratio 1.66) with pyuria was observed. Kidney sonography showed parenchymal swelling and increased renal echogenicity. Due to rapidly progressing nephritis, steroid pulse therapy (750 mg/IV) was done on the second day of his admission and the patient showed complete recovery with normal renal function. However, the kidney biopsy findings revealed renal cortical hemorrhagic necrosis. Multifocal, relatively well-circumscribed, hemorrhagic necrotic areas (about 25%) were detected in the tubulointerstitium. Although RCN is an unusual cause of AKI, especially in children, pediatricians should consider the possibility of RCN when evaluating patients with rapidly decreasing renal function.

• Archives of Plastic Surgery
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• 제49권1호
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• pp.61-69
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• 2022

Background Single free flaps are a commonly used reconstructive method for multiple soft tissue defects in digits. We analyzed the flap size, division timing, and degree of necrosis in cases with various types of flap division. Methods We conducted a retrospective review of the medical charts of patients who had undergone single free flap reconstruction for multiple soft tissue defects across their digits from 2011 to 2020. The flap types included were the lateral arm free flap, venous forearm free flap, thenar free flap, hypothenar free flap, anterolateral thigh free flap, medial plantar free flap, and second toe pulp free flap. Flap size, anastomosed vessels, division timing, and occurrence of flap necrosis were retrospectively investigated and then analyzed using the t-test. Results In total, 75 patients were included in the analysis. The success rate of the free flaps was 97.3%. All flaps were successfully divided after at least 17 days, with a mean of 47.17 days (range, 17-243 days) for large flaps and 42.81 days (range, 20-130 days) for the medium and small flaps (P=0.596). The mean area of flap necrosis was 2.38% in the large flaps and 2.58% in the medium and small flaps (P=0.935). Severe necrosis of the divided flap developed in two patients who had undergone flap division at week 6 and week 34. Conclusions In cases where blood flow to the flap has been stable for more than 3 weeks, flap division can be safely attempted regardless of the flap size.

• Korean Journal of Radiology
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• 제20권5호
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• pp.801-811
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• 2019

Objective: To determine whether diffusion kurtosis imaging (DKI) is effective in monitoring tumor response to neoadjuvant chemotherapy in patients with osteosarcoma. Materials and Methods: Twenty-nine osteosarcoma patients (20 men and 9 women; mean age, 17.6 ± 7.8 years) who had undergone magnetic resonance imaging (MRI) and DKI before and after neoadjuvant chemotherapy were included. Tumor volume, apparent diffusion coefficient (ADC), mean diffusivity (MD), mean kurtosis (MK), and change ratio (ΔX) between pre-and post-treatment were calculated. Based on histologic response, the patients were divided into those with good response (≥ 90% necrosis, n = 12) and those with poor response (< 90% necrosis, n = 17). Several MRI parameters between the groups were compared using Student's t test. The correlation between image indexes and tumor necrosis was determined using Pearson's correlation, and diagnostic performance was compared using receiver operating characteristic curves. Results: In good responders, MD_post, ADC_post, and MK_post values were significantly higher than in poor responders (p < 0.001, p < 0.001, and p = 0.042, respectively). The ΔMD and ΔADC were also significantly higher in good responders than in poor responders (p < 0.001 and p = 0.01, respectively). However, no significant difference was observed in ΔMK (p = 0.092). MD_post and ΔMD showed high correlations with tumor necrosis rate (r = 0.669 and r = 0.622, respectively), and MD_post had higher diagnostic performance than ADC_post (p = 0.037) and MK_post (p = 0.011). Similarly, ΔMD also showed higher diagnostic performance than ΔADC (p = 0.033) and ΔMK (p = 0.037). Conclusion: MD is a promising biomarker for monitoring tumor response to preoperative chemotherapy in patients with osteosarcoma.

• 약학회지
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• 제33권2호
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• pp.101-110
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• 1989

These studies were attempted to investigate the therapeutic effect earthworm (Lamnodrilus gotai Hatai) extract (LS) on the liver damage induced by carbon tetrachloride ($CCl_4$) in rats. Male rats (Sprague-Dawley) were treated with sub-chronic concentration of $CCl_4$, which was 0.2 ml/kg of $CCl_4$ via peroral administration twice a week. LS administration to rats (6 ml/kg,po) prevented the development of fatty liver, necrosis and fibrosis induced by $CCl_4$. Furthermore, as compared with rats suspended after treated with $CCl_4$ only, LS treatment significantly decreased the increment in serum enzyme activities, liver enlargement and improved growth rate. This protective effect was observed when LS was given monthly for 4 months after $CCl_4$ treated for 2 months. These results suggest that earthworm extract has appreciable therapeutic effect on $CCl_4$-induced hepatotoxicity.